NPIMap

Organization Active NPI

Our Lady of Lourdes Health Center

Doing business as Lourdes Riverview Medical Group

  • Family Medicine Physician
  • Pasco, WA
National Provider Identifier
1184708471
Registry record updated Apr 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
113003371 Issued in WA
Legal business name
OUR LADY OF LOURDES HEALTH CENTER
Doing business as
Lourdes Riverview Medical Group
Practice address
4403 W Court St
Suite B
Pasco, WA 99301-2879
Phone
(509) 545-5358
NPI assigned
Oct 24, 2006
Last updated
Apr 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John Serle
Title
President & Ceo
Phone
(509) 543-2483

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 113003371 WA Primary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X 113003371 WA
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X 113003371 WA

Addresses

Primary practice location

4403 W Court St
Suite B
Pasco, WA 99301-2879

Mailing address

4403 W Court St
Suite B
Pasco, WA 99301-2879
Phone (509) 545-6620

Other identifiers 1

IdentifierTypeStateIssuer
7093933MedicaidWA

Other names 1

  • LOURDES RIVERVIEW MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

4403 W Court St
Ste B
Pasco, WA 99301
Phone (509) 416-8880

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239926400000",
    "number": "1184708471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 W COURT ST",
            "address_2": "SUITE B",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993012879",
            "telephone_number": "509-545-6620",
            "fax_number": "509-545-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 W COURT ST",
            "address_2": "SUITE B",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993012879",
            "telephone_number": "509-545-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF LOURDES HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2009-04-17",
        "status": "A",
        "authorized_official_last_name": "SERLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "509-543-2483",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "113003371",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "113003371",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "WA",
            "license": "113003371",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7093933",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LOURDES RIVERVIEW MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasco, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.